间歇性经口至食管管饲法对脑卒中后吞咽障碍患者病耻感的影响

目的:了解间歇性经口至食管管饲(IOE)法对脑卒中后吞咽障碍患者病耻感的影响。方法:脑卒中后吞咽障碍患者80例随机分为IOE组和持续经鼻至胃管饲(NGT)组,各40例。于治疗前、后,分别采用简明健康调查表(SF-36量表)、抑郁自评量表(SDS)和慢性疾病病耻感量表(SSCI)评价2组生活质量、抑郁状态和病耻感。结果:治疗后,2组各维度的生活质量评分均较治疗前明显提高(均P0.05),IOE组生活质量更高于NGT组(P0.05);治疗后,NGT组和IOE组的SDS评分均低于同组治疗前(均P0.05),且IOE组低于NGT组(均P0.05);治疗后,2组SSCI病耻感总分、内在病耻感、外在病耻感得分均较治疗前降低(均P0.05);IOE组SSCI病耻感总分、内在病耻感、外在病耻感得分低于NGT组(均P0.05)。结论:与NGT相比,IOE更有助于改善脑卒中后吞咽功能障碍患者的生活质量、同时降低其抑郁情绪及慢病病耻感。     

抑郁症患者自我怜悯水平与其快感缺失的相关性分析

目的对抑郁症患者自我怜悯水平与其快感缺失的相关性进行分析。方法选取2019年1月~2020年1月我院收治的35例抑郁症病患作为研究组,另外选择35例健康者作为对照组。选取自我怜悯量表(SCS-C)、社会快感缺失量表(RSAS-C)与躯体快感缺失量表(BPAS-C)对对照组患者进行评估,研究组在对照组评估的基础上加以Bech抑郁自评量表(BDI)评估。研究两组自我怜悯水平与快感缺失情况。研究组SCS-C评分及各项因子水平均明显低于对照组,RSAS-C及RPAS-C评分均明显高于对照组,差异显著(P<0.05);研究组SCS-C评分及各项因子评分与STAI、BDI、RPAS-C、RSAS-C评分存在负相关,差异具有统计学意义(P<0.05),SCS-C总评分与RPAS-C及RSAS-C评分相关生差异无显著性(P>0.05)。结论抑郁症患者的自我怜悯水平普遍较低,与其缺失躯体快感及缺失社会快感相关联。     

引导式教育训练对首发精神分裂症患者自我病耻感的影响

目的观察引导式教育训练对首发精神分裂症患者自我病耻感的影响。方法第一阶段将40例首发精神分裂症患者按随机数字表分为A组和B组各20例,A组给予抗精神病药物治疗和工娱治疗,B组给予抗精神病药物治疗和引导式教育训练;第二阶段首发精神分裂症患者20例(C组),给予抗精神病药物治疗并与其家属一起接受引导式教育训练。训练时间均为4周;比较干预前后3组患者精神疾病内在病耻感评估得分。结果第一阶段A组和B组患者干预前后自我病耻感评估得分组内比较差异无统计学意义,干预后B组患者自我病耻感评估得分低于A组患者,差异有统计学意义;第二阶段干预后C组患者及家属组自我病耻感评估得分低于干预前,C组患者自我病耻感评估得分低于A组和B组患者,差异均有统计学意义。结论患者与家属共同接受引导式教育训练可降低首发精神分裂症患者的自我病耻感。     

双相障碍抑郁发作病人病耻感与正念水平的相关性研究

[目的]探讨双相障碍抑郁发作病人病耻感与正念水平的相关性,为开展临床心理干预提供思路。[方法]2017年1月—2018年8月采用一般资料调查表、Link病耻感系列量表和五因素心智觉知度量表对山西省某综合医院精神卫生科160例双相障碍抑郁发作病人进行调查。[结果]双相障碍抑郁发作病人贬低-歧视感知量表得分为(2.61±0.43)分,病耻感应对量表得分为(2.82±0.47)分,病耻感情感体验量表得分为(2.75±0.60)分,均高于该量表均值(P0.05);正念水平与病耻贬低-歧视感知量表得分(r=-0.515)、病耻感应对量表得分(r=-0.686)、病耻感情感体验量表得分(r=-0.592)呈负相关。多元线性回归分析显示,正念水平和病程是双相障碍抑郁发作病人病耻感重要的预测变量。[结论]双相障碍抑郁发作病人病耻感较高,提高病人的正念水平有助于降低其病耻感体验。     

精神分裂症患者病耻感与家庭亲密度的相关性研究

目的观察精神分裂症患者治疗期间病耻感及家庭亲密度状况,并分析病耻感与家庭亲密度的关系。方法前瞻性选取2017年1月-2020年1月医院诊治并接受随访的84例精神分裂症(巩固治疗期)患者,所有患者均接受抗精神病药物治疗,均治疗6个月,分别于治疗前、治疗3个月、治疗6个月,采用精神疾病内在病耻感调查表(Stigma scale of intrinsic diseases in mental disorders, ISMI)评估患者病耻感,采用参照家庭亲密度与适应性量表(Family Adaptability and Cohesion Evaluation Scales, FACES)自制的量表评估患者的家庭亲密度状况;观察不同时点精神分裂症患者病耻感及家庭亲密度评分各维度变化,分析病耻感与家庭亲密度的相关性。结果治疗3个月,精神分裂症患者疏远、刻板认同、歧视经历、社会退缩、病耻感抵抗、总分评分均低于治疗前,且治疗6个月,上述各维度及总分评分均低于治疗3个月,差异有统计学意义(P0.001);治疗3个月,家庭实际情况、理想中家庭状况、总分评分比较差异均有统计学意义(P0.05);且治疗6个月,上述各维度及总分评分均低于治疗3个月,差异有统计学意义(P0.001);相关性分析结果显示,精神分裂症患者病耻感(ISMI评分各维度评分)与家庭亲密度(各维度及总分)均呈正相关(r0,P0.05)。结论精神分裂症患者病情不断康复,其家庭亲密度整体改善,且病耻感程度不断降低,患者治疗期间病耻感及家庭亲密度存在一定联系,二者间呈正相关的关系。     

抑郁症患者自我怜悯与共情能力现状的相关性分析

目的调查分析抑郁症患者自我怜悯与共情能力的现状。方法选取我院2019年4—7月收治的360例患者为研究对象,其中180例非抑郁症患者作为对照组,180例抑郁症患者作为研究组,分别采用自我怜悯量表(SCS-C)、人际反应指针量表(IRI-C)以及汉密尔顿抑郁量表(HAMD-17)进行评估,观察两组SCS-C、IRI-C以及HAMD-17得分情况以及两组之间相关性。结果研究组IRI-C得分中,观点采择得分低于对照组,个人痛苦得分高于对照组;SCS-C各项得分低于对照组(P<0.05)。抑郁症患者SCS-C总分及其各因子与观点采择呈正相关性,与个人痛苦和抑郁程度呈负相关性,均存在统计学意义(P<0.05);抑郁程度与个人痛苦呈正相关(P<0.05)。结论抑郁症患者自我怜悯水平普遍较低,同时共情能力也存在相应缺陷,两者之间具有一定影响。     

团体教育联合正念认知训练对康复期精神分裂症病人自尊及自我效能感的影响

[目的]探讨团体教育联合正念认知训练对康复期精神分裂症病人自尊及自我效能感的影响。[方法]将入组122例康复期精神分裂症病人按照随机分组方法分为对照组及干预组,对照组61例实施常规护理,干预组61例在常规护理的基础上实施团体教育联合正念认知训练。采用罗森伯格自尊量表(SES)及一般自我效能感量表(GSES)对两组研究对象进行干预前后的自尊及自我效能感进行评价。[结果]干预前两组自尊及自我效能感得分比较,差异无统计学意义(P0.05);干预后干预组自尊量表及一般自我效能感量表得分高于对照组,差异均有统计学意义(P0.05)。[结论]团体教育联合正念认知训练能提高康复期精神分裂症病人自尊及自我效能感。     

音乐疗法对慢性精神分裂症患者生活质量，社会功能 以及自尊感的影响

目的:探讨音乐疗法对精神分裂症患者生活质量、社会功能及自我尊重感的影响。方法:确诊为慢性精神分裂症的患者120例随机分为2组,各60例。对照组给予抗精神病药物治疗,治疗组给予抗精神病药物及音乐疗法,疗程3个月。治疗前、后,以生活质量量表(SQLS)评价患者生活质量,以个人和社会功能量表(Ps P)评价患者社会功能,以自尊量表(SES)评价患者自我尊重感。结果:治疗3个月后,治疗组的SQLS评分低于同组治疗前及对照组(P0.05),对照组治疗前后差异无统计学意义(P0.05);治疗组的Ps P评分低于同组治疗前及对照组(P0.05),对照组治疗前后差异无统计学意义(P0.05);2组SES评分变化差异无统计学意义(P0.05)。结论:音乐疗法辅助常规抗精神病药物治疗可明显改善慢性精神分裂症患者生活质量及社会功能,但并不能有效改善患者自尊感。     

自我角色认同护理干预对康复期精神分裂症患者的影响

目的:探讨自我角色认同护理干预对康复期精神分裂症(SP)患者的影响。方法:选取2015年1月1日～2018年12月31日收治的住院SP患者80例,按照随机数字表法分为观察组和对照组各40例,对照组采用常规护理,观察组在常规护理基础上实施自我角色认同护理干预,两组均持续护理12周;比较两组干预前后自我效能[采用自我效能感量表(GSES)]、病耻感[采用精神疾病病耻感量表]、激越行为[采用激越行为量表(CMAI)]、生活质量[采用精神分裂症生活质量量表(SQLS)]、康复效果[采用简明精神分裂症评定量表(BPRS)]。结果:干预后,观察组GSES评分显著高于对照组和干预前(P0.01,P0.05);干预后,观察组CMAI、SQLS、BPRS、病耻感评分显著低于对照组和干预前(P0.01,P0.05)。结论:自我角色认同护理干预可有效提高康复期SP患者自我效能,减少激越行为,降低病耻感,提高患者生活质量和康复效果。     

综合护理干预对康复期精神分裂症患者病耻感及社会功能的影响

目的 探讨综合护理干预对康复期精神分裂症患者病耻感及社会功能的作用.方法 选取60例康复期精神分裂症患者按随机数字表法随机分为干预组和对照组各30例,对照组予精神科常规护理,干预组予12周的综合护理干预,两组在治疗前后分别予病耻感评估量表及护士用住院病人观察量表（NOSIE）评定,并比较两组结果.结果 干预前两组患者病耻感得分及NOSIE量表各因子评分比较差异均无统计学意义（P＞0.05）;经过12周的综合护理干预,干预组病耻感得分（25.52±10.33）分,NOSIE量表中社会功能（21.85±4.46）分、社会兴趣（11.02±3.06）分、个人整洁（15.35±2.29）分、抑郁（3.03±1.44）分,与干预前[（38.10±15.50）,（18.46 ±5.65）,（7.78±3.14）,（12.15±3.30）,（3.76±1.37）分]及对照组[（32.26±12.15）,（18.89±3.36）,（9.34±1.98）,（11.57±3.02）,（4.20±1.53）分]比较差异均有统计学意义（P＜0.05）;对照组病耻感得分与干预前比较差异无统计学意义（P＞0.05）.结论 综合护理干预能降低精神分裂症患者的病耻感,改善患者的社会功能,提高其生活质量.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Prospects for the control of neglected tropical diseases by mass drug administration

The prospects for the control of neglected tropical diseases, including soil-transmitted helminthiasis, shistosomiasis, lymphatic filariasis, onchocerciasis and trachoma, through mass drug administration, are exemplified by the elimination of the trachoma as a public-health problem in Morocco. In spite of this and other striking successes, mass drug administration programs are faced with major challenges resulting from suboptimal coverage and lack of efficacy. At current suboptimal coverage rates, programs may need prolongation for an extended period, increasing costs and undermining sustainability. Community participation through health education and information appears to be crucial to improve coverage and to achieve sustainability. Implementation of complementary measures, such as vector control, improved hygiene and environmental sanitation, are important to further control transmission and to prevent re-emergence of the infection and, again, may only be achieved effectively through community-based initiatives. To reduce costs and to relieve pressure on the health system, combining neglected tropical disease programs in areas where diseases coexist and integration with existing control programs for malaria, tuberculosis and HIV/AIDS is advocated. The risk of developing drug resistance is of particular concern in view of the lack of alternative drugs, and reduced treatment efficacy due to emerging resistance is evident for the soil-transmitted helminths and onchocerciasis. Given the risk for the development of drug resistance and the need for a high degree of participation, close attention should be paid to the monitoring of the coverage and efficacy of the different program components.     

Bacterial meningitis: an update of new treatment options

The outcome of bacterial meningitis critically depends on the rapid initiation of bactericidal antibiotic therapy and adequate management of septic shock. In community-acquired meningitis, the choice of an optimum initial empirical antibiotic regimen depends on the regional resistance patterns. Pathogens resistant to antibacterials prevail in nosocomial bacterial meningitis. Dexamethasone is recommended as adjunctive therapy for community-acquired meningitis in developed countries. In comatose patients, aggressive measures to lower intracranial pressure <20 mmHg (in particular, external ventriculostomy, osmotherapy and temporary hyperventilation) were effective in a case–control study. Although many experimental approaches were protective in animal models, none of them has been proven effective in patients. Antibiotics, which are bactericidal but do not lyse bacteria, and inhibitors of matrix metalloproteinases or complement factor C5 appear the most promising therapeutic options. At present, vaccination is the most efficient method to reduce disease burden. Palmitoylethanolamide appears promising to enhance the resistance of the brain to infections.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Imaging choices in occult hip fracture

Background: Hip fracture is a common injury, with an incidence rate of > 250,000 per year in the United States. Diagnosis is particularly important due to the high dependence on the integrity of the hip in the daily life of most people. Objectives: In this article we review the literature focused on hip fracture detection and discuss advantages and limitations of each major imaging modality. Discussion: Plain radiographs are usually sufficient for diagnosis as they are at least 90% sensitive for hip fracture. However, in the 3–4% of Emergency Department (ED) patients having hip X-ray studies who harbor an occult hip fracture, the Emergency Physician must choose among several methods, each with intrinsic limitations, for further evaluation. These methods include computed tomography, scintigraphy, and magnetic resonance imaging. Conclusion: We present an evidence-based algorithm for the evaluation of a patient suspected to have an occult hip fracture in the ED. Also outlined are future directions for research to distinguish more effective techniques for identifying occult hip fractures.     

Systematic Reviews Published in the April 2012 Issue of the Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD but monthly online. The April 2012 issue (second DVD for 2012) contains 5045 complete reviews, 2182 protocols for reviews in production, and 17,084 short summaries of systematic reviews published in the general medical literature. In addition, there are citations of 674,000 randomized controlled trials, and 15,400 cited papers in the Cochrane methodology register. The health technology assessment database contains just over 11,000 citations. One hundred and seventeen new reviews have been published in the last 3 months of which 12 have potential relevance for practitioners in pain and palliative medicine. The impact factor of the Cochrane Library stands at 6.186. Readers are encouraged to access the full report for any articles of interest as only a brief commentary is provided.     

Platelets,thrombosis, coagulation,and atherosclerosis

When I first got the invitation to join a medical delegation going to Moldova, I thought for a moment that our destination was the fictional country in the old Marx Brothers movie Duck Soup. On further checking, it turns out that entertaining place was called Freedonia. I now know that Moldova is indeed a real country, bordered on the west by Romania and on the other three sides by the Ukraine. It is a proud country, rich with traditions, and its people are warm, giving, eager to learn ways to improve their healthcare system, and deeply appreciative of our attempts to help them in the task.